President Donald Trump. Vice-President Mike Pence. A Republican-controlled House and Senate. And at least one new conservative justice to the Supreme Court. Even a week later, the reality of just how dramatically this nation will change on Inauguration Day still hasn’t even begun to sink in. By 24 hours post-election, I was positive that this could be the end of Roe v. Wade. Now, I’m worried that is just the beginning.

There really isn’t any doubt that Roe is on the rocks. Trump promised abortion opponents that a federal 20-week abortion ban will be his top priority if they helped him get into the White House. And, as I explain in great detail in my book on how the right hopes to overturn Roe, a pre-viability ban based on the scientifically unsupported claim that a fetus feels pain opens the door to then let states to claim fetuses and embryos feel pain as early as six weeks post-conception, letting states essentially block almost all abortion access until they are allowed to make it completely illegal within their borders.

Trump, meanwhile, has now made it clear that his has absolutely no idea what sort of national impact overturning Roe would have on abortion access. “Yeah, well, they’ll perhaps have to go—they’ll have to go to another state,” Trump told 60 Minutes on Sunday, when asked what would happen if Roe were reversed and states could ban abortion completely. What he apparently fails to recognize—or worse, knows but simply doesn’t care about—is that the states that would again criminalize abortion form large swaths of the country, making it impossible to just hop across a border to find a new provider.

If state legislatures could once more make abortion illegal, there is unlikely to be a single state along the Gulf Coast in which a safe, legal abortion could be obtained. Florida would be the best hope of accessing clinic, and even that state could lose access if their GOP legislature passed a bill. Most of the plains states would also likely make abortion illegal, cutting a path from Texas all the way up to Canada where terminating a pregnancy would be a crime. In a best-case scenario, abortion would be available in less than 20 states.

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Then there are the possibilities that are literally keeping me awake at night. Most of the members of Trump’s “pro-life advisory council” believe that birth control is as bad as abortion, and actually increases the abortion rate. Meanwhile, current GOP Speaker of the House Paul Ryan has indicated that keeping no co-pay birth control coverage in their new health-care law isn’t a priority. Both Congress and the President-elect have agreed that defunding Planned Parenthood is at the top of their agenda, and the transition website’s health-care policy planks include expanded “conscience” protections—meaning even more opportunities for employers to refuse to have birth control coverage in their insurance plans, or for doctors and pharmacists to refuse to prescribe or fill hormonal birth control prescriptions.

In other words, the administration appears poised to make all forms of birth control even more difficult to afford, and give even more power to more people to block you from buying it even when you can.

If that sounds alarmist, consider the fact that the transition website’s verbiage is drawn directly from anti-abortion “personhood” language. It states that the administration will act to “Protect innocent human life from conception to natural death, including the most defenseless and those Americans with disabilities.” “Conception to natural death” is first and foremost the Catholic Church’s terminology for its opposition to birth control, abortion and euthanasia. It’s also the backbone of so-called “Personhood” bills, the controversial no-exceptions abortion bans that are hotly debated over whether they do or do not also ban hormonal contraception, emergency contraception and in vitro fertilization, too.

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It wouldn’t be outside the realm of possibility to say that by the end of Trump’s term, we could well be looking at a scenario where birth control is unaffordable for those of moderate or low incomes, abortion is available in just a handful of states outside the West and East Coast, such as Minnesota, Colorado, and Illinois, and abortion after 20 weeks simply will not be legally possible—not even if the fetus has anomalies—and only if pregnant sexual assault survivors literally justify themselves to a psychologist and then wait an additional 48 hours afterward to terminate. That is, if they can find a doctor even willing to do it.

Maybe it won’t get that bad. Maybe we can manage to keep Trump to just one Supreme Court justice, and Democrats can take over the Senate in 2018 (despite the very bad odds on that one) to keep the right from completely dismantling all reproductive rights. Maybe we don’t need to worry endlessly that the fate of a person’s ability to be pregnant and give birth when that person wants to is literally resting on the shoulders of three liberal judges all aged 78 or older, or that the person who will be signing federal abortion legislation had to be hand-held and walked back from his statement that women should be punished if they choose an illegal abortion rather than continue an unwanted pregnancy. Maybe we really can hold all the fingers in the dike for another four years and keep the GOP from doing irreversible and life-altering harm.

But I will be frank: The last six years nearly destroyed abortion access altogether. Six states have one clinic, and we have hundreds of miles without any providers at all. Abortion was out of reach financially and physically for thousands, and the only thing that made that less of a disaster was the increase in accessible, effective birth control that prevented many more unintended pregnancies in the first place. Meanwhile, anti-abortion activists had a brief glimpse of a potential future without a conservative Supreme Court to back up their agenda, and will be working furiously to push for new gains now that they’ve once more regained the upper hand.

I wish I had a positive thought to end this with, but I don’t. After all, we are talking about President Donald Trump, a Republican-controlled House and Senate, and at least one new conservative justice to the Supreme Court. And no matter how many times I say it, it is still impossible for me to fully comprehend.

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About the Author

Robin Marty is a freelance writer and speaker and the author of CROW AFTER ROE, a book outlining the blueprint to end abortion one red state at a time. Marty’s articles have appeared at Cosmopolitan.com, Politico, The Guardian, and other publications, and she is a Women’s Media Center SheSource Expert on Reproductive Rights and Politics. Follow her: @robinmarty